PSYCHODYNAMIC FRAME OF REFERENCE

                         

                      PSYCHODYNAMIC FRAME OF REFERENCE

1. THEORY:

·         psychodynamic theory is one of the few occupational therapy (OT) approaches that deals effectively with emotional issues’ (Cole and Tufano 2008, p. 255).

·         Psychodynamic approaches to group counseling. stress insight in therapy (psychoanalytic and Adlerian therapy)

·         Two key features of psychodynamic group therapy are ways that transference and countertransference are played out in the context of the current group situation.

2. BASIC ASSUMPTIONS:

·         Psychodynamic theory and approaches developed from the work of Sigmund Freud and his followers. Freudian thinking views people as having both a conscious and an unconscious mind.

·         Behaviour is largely influenced by material in the unconscious mind, therefore people are usually not aware of why they act in particular ways and their actions are not always under conscious control.

·         Actions are taken to gratify needs, but not necessarily those needs of which the individual is consciously aware.

·         People have an innate drive to be active that is directed towards gratifying needs and making satisfactory relationships.

·         Action is used to express and communicate feelings and thoughts.

·         Action arises from mental images, and feedback about the results of action allows these images to be modified to match external reality

·         The infant strives for competence in actions that will both meet the infant’s needs and increase their sense of personal identity and integrity

·          A sense of self-worth comes from intrinsic satisfaction in doing well in the areas of life that the infant values.

·         The more situations and actions the child is able to experience, the greater will be their knowledge of their own potential and limitations, leading to greater adaptability.

·          Knowledge of what patterns of action are most useful and acceptable in the individual’s culture is learned through interaction with the social environment.

3. KNOWLEDGE BASE:

·         The occupational therapist working within a psychodynamic frame of reference will have knowledge and understanding of:

Ø  Psychiatry   

Ø  Psychoanalytic theory   

Ø  Psychopathology

Ø   Group dynamics

Ø  The symbolic meaning and potential of activities and materials

Ø   Object relations theory.

4. GOALS:

·         The goals of intervention :

Ø  Assist in finding ways to gratify frustrated basic needs

Ø   Reverse psychopathology

Ø  Provide conditions for normal psychosexual and psychosocial development

Ø   Facilitate the development of a more realistic view of the self in relation to action and to others

Ø   Help to build a more healthy and integrated ego

·         Two main approaches associated with this frame of reference:

          Explorative approach assumes that the content of the unconscious can best be dealt with by bringing it into the conscious mind. The client then has the opportunity to find more adaptive ways of resolving conflicts and accepting difficult or painful feelings.

          A supportive approach aims to keep unresolved conflicts and painful feelings hidden in the unconscious mind and to strengthen the client’s ego defence mechanisms so that material does not leak into the conscious mind and cause problems.

5. ASSESSMENT AND INTERVENTION:

·         A psychodynamic frame of reference there may be no clear distinction between assessment and intervention.

·         The activities that help to bring unconscious material into the conscious mind allow for a clearer understanding of underlying conflicts while at the same time beginning the process of resolving those conflicts. The client’s progress is apparent in the way they respond to the activities provided as interventions.

·         In both supportive and explorative approaches, the therapeutic elements of occupational therapy include:

Ø  Actions of the client

Ø  Objects used in, or resulting from, action;

Ø   Human and non-human environments, and interpersonal relationships.

·         Activities are selected for their symbolic potential as well as their potential to provide an appropriate level and type of social interaction.

·         Activity analysis is in terms of the psychodynamics of activity, the symbolic potential of materials and actions, interpersonal aspects and sociocultural significance (Fidler 1999b).

·         The choice of activities may be made by the therapist or client, depending upon their needs. However, the client has to be an active participant in the therapeutic process if it is to be of value to them. During intervention, close liaison with other team members is essential and supervision is always part of the process (Blair and Daniel 2006). Intervention planning takes account of the amount of support and structure available to the therapist, as well as the support available to the client outside of intervention sessions.

·         Intervention may be individual or in groups but the group should always be small enough to allow the  clients to relate closely to everyone in it: 8–10  members is usually considered to be the optimum size.

·         A supportive psychotherapy group would aim to:

Ø  Offer encouragement

Ø   Provide opportunities for mutual support

Ø   Provide a forum for exchanging information about resources

Ø   provide a place to air problems

Ø   Help to relieve anxiety

Ø   Give opportunities to consider new ways of dealing with problems.

·         Occupational therapy has contributed activity to the process, with the use of the creative arts as ego- explorative activities (Blair and Daniel 2006). involves:

Ø  The presentation of stimuli to which participants can respond with feelings or thoughts (e.g. a piece of music or a poem), or

Ø   The creation of a piece of work through which participants can express feelings or thoughts (e.g. a painting or a piece of free clay modelling)

 6. PSYCHODYNAMIC APPROACHES:   STRESS INSIGHT IN THERAPY (PSYCHOANALYTIC AND ADLERIAN THERAPY)

      6.1. Psychoanalytic therapy

·         Psychoanalytic therapy is based largely on insight, unconscious motivation, and reconstruction of the personality.

·          The psychoanalytic model has had a major influence on all of the other formal systems of psychotherapy. Some of the therapeutic models we consider are basically extensions of the psychoanalytic approach, others are modifications of analytic concepts and procedures, and still other theories emerged as a reaction against psychoanalysis.

        6.1.1 Key Concepts of Psychoanalytic Therapy:

·         Psychoanalytic group therapy focuses on the influence of the past on current personality functioning.

·         The psychoanalytic approach views people as being significantly influenced by unconscious motivation and early childhood experiences. Because the dynamics of behavior are buried in the unconscious, group therapy often consists of a lengthy process of analyzing inner conflicts that are rooted in the past.

       6.1.2 Therapeutic Goals of Psychoanalytic Therapy:

·         To make the unconscious conscious.

·         Rather than solving immediate problems, the goal is the restructuring of personality. Successful outcomes of psychoanalytic therapy result in significant modification of an individual’s personality and character structure.

      6.1.3 Therapeutic Relationship:

·         Leadership styles vary among psychoanalytically oriented group therapists, ranging from leaders characterized by objectivity, warm detachment and relative anonymity to those who favor a role that is likely to result in a collaborative relationship with group members

·         A significant development of psychoanalytically oriented group therapy is the growing recognition of the central importance of the therapeutic relationship.

     6.1.4 Techniques:

·         These techniques are geared to increasing awareness, acquiring insight, and beginning a working-through process that will lead to a reorganization of the personality.

·         Major techniques include:

ü  Maintaining the analytic framework

ü  Free association

ü  Interpretation

ü   Dream analysis

ü   Analysis of resistance

ü   Analysis of transference

6.2. Adlerian Therapy

·         Adlerians focus on meaning, goals, purposeful behavior, conscious action, belonging, and social interest. Although Adlerian theory accounts for present behavior by studying childhood experiences, it does not focus on unconscious dynamics.

·         Adlerian therapy has a psychoeducational focus, a present- and future-orientation, and is a brief or time-limited approach.

     6.2.1 Key Concepts of Adlerian Therapy:

·         According to the Adlerian approach, people are primarily social beings, influenced and motivated by societal forces. Human nature is viewed as creative, active, and decisional.

·          The approach focuses on the unity of the person, on understanding the individual’s subjective perspective, and on the importance of life goals that give direction to behavior.

·          Adler holds that inherent feelings of inferiority initiate a natural striving toward achieving a higher level of mastery and competence in life.

·         The subjective decisions each person makes regarding the specific direction of this striving form the basis of the individual’s lifestyle (or personality style). The style of life consists of our views about others, the world, and ourselves; these views lead to distinctive behaviors that we adopt in pursuit of our life goals.

·         We can influence our own future by actively and courageously taking risks and making decisions in the face of unknown consequences

      6.2.2 Therapeutic Goals of Adlerian:

·         Adlerian group is fostering social interest, or facilitating a sense of connectedness with others.

·         Adlerian leaders want to cultivate in members the desire to contribute to the welfare of others, to enhance a sense of identification and empathy with others, and to enhance a sense of belongingness with a group.

·         To accomplish this goal, an Adlerian leader creates a democratic climate within the group.

       6.2.3 Therapeutic Relationship Adlerians:

·         Adlerians base their therapeutic relationship on cooperation, mutual trust, respect, confidence, collaboration, and alignment of goals.

·         They especially value the group leader’s modeling of communication and acting in good faith. From the beginning of a group, the relationship between the leader and the members is collaborative and is characterized by working toward specific, agreed-upon goals.

·         Adlerian group therapists strive to establish and maintain an egalitarian therapeutic alliance and a person-to-person relationship with the members of their groups.

       6.2.4 Techniques:

·         Adlerians have developed a variety of techniques and therapeutic styles. Adlerians are not bound to follow a specific set of procedures; rather, they can tap their creativity by applying those techniques that they think are most appropriate for each client.

·         Some of the specific techniques :

ü  Employ are attending

ü  Providing both confrontation and support

ü  Summarizing

ü  Gathering life history data

ü  Lifestyle analysis

ü  Interpretation of experiences within the family and early recollections,

ü  Suggestion

ü  Offering encouragement,

ü  Homework assignments,

ü  Assisting group members in searching for new possibilities.